Introduction Patient participation was mandatory when a National system for Knowledge-based management of healthcare was launched in Sweden aiming to enhance a person-centered learning health system. The patient representatives co-produce person-centered and cohesive clinical pathways in collaboration with professional representatives in national groups to describe assessment, diagnosis, planning and evaluation for a specific condition. The chairperson and process leader in the respective group and the support function for the system, support the process of producing clinical pathways. Healthcare professionals and patient representatives jointly constructing clinical pathways is a significant but less studied strategy. The present study therefore aimed to explore and describe the experiences of patient participation at a national level and in this context. Method In this qualitative study, patient representatives took part in the planning, analysis, and the final version of publication phase. Individual interviews were conducted digitally with nine patient and eight healthcare professional representatives (process leaders and chairpersons) with experience of participating in producing clinical pathways for acute and chronic conditions, representing 18 national groups. A semi-structured interview guide was iteratively discussed and refined in the research group. The transcribed interviews were analyzed using inductive qualitative content analysis. Results Three main categories were identified: Finding appropriate patient representatives – relating to the recruitment process, formal and informal competence and prerequisites and demands. Working methods that facilitate a patient perspective – relating to for example group member interaction, strategies to support participation, meeting forms and learning. Influence of the patient perspective in the clinical pathways processes – including enhancing a patient perspective. The experiences were similarly expressed for both patient and professional healthcare representatives. However, the patient representatives also expressed concern regarding the implementation and utilization of the pathways. Key learnings and practical implications were feedbacked to the National system for Knowledge-based management.